ESS'98
October 26-28, 1998
FAX/MAIL REGISTRATION FORM
(
or use the electronic form)

Please legibly print or type and fill out completely.

NAME
 
LAST
 
FIRST
 
M.I.
 
COMPANY OR AFFILIATION
 
Mailing address (tick one): [ ] HOME [ ] BUSINESS
STREET
 
CITY
 
ZIPCODE
 
COUNTRY
 
TELEPHONE
 
FAX
 
E-MAIL
 
DATE
 
SIGNATURE
 

 

REGISTRATION AND PAYMENT
A.CONFERENCE REGISTRATION (Check appropriate boxes)
1. [ ] SCS member BF 17.000 / 285 / ECU 425
Member Number:_____________________________
BF/ECU
___________
2. [ ] Members of Sponsor or Affiliate Society
BF 17.000 / 285 / ECU 425
Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS
BF/ECU
___________
3. [ ] Non-Member Participant
BF 19.000 / 320 / ECU 475
BF/ECU
___________
4. [ ] For registration AFTER September 15, add
BF 2.000 / 35 / ECU 50
BF/ECU
___________
5. [ ] Students, who are not authors but who wish to attend the conference pay:
BF 9.000 / 150 / ECU 225
BF/ECU
___________
(Above registration fees include, TUTORIALS, one copy of the PROCEEDINGS-CD-Rom, all midday meals, cocktail, refreshments, coffees and social program, except for students where the Conference Proceedings are NOT INCLUDED.)  
6. [ ] Conference Dinner Ticket for Companion
BF 1300 / 22 / ECU 33
BF/ECU
___________
VAT Number if applicable: _______________________________
TOTAL AMOUNT DUE BF/ECU
___________
ADD BANK CHARGE of BF 400 ( 7 / ECU 10) in case you pay by BANK or CHEQUE. BF/ECU
___________
TOTAL AMOUNT REMITTED BF/ECU
___________

[ ] 1)

Make payment by BANK TRANSFER to account No. 290-0033837-05 SCS Europe BVBA, SOCIETE GENERALE DE BANQUE, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium MENTION YOUR NAME and Euromedia'98
[ ] 2) Or pay by CHEQUE and send it to SCS European Office, European Simulation Office, University of Ghent, Coupure Links 653, B-9000, Ghent, Belgium.
[ ] 3) Or pay by CREDIT CARD and fill in the information below:
  Charge my (tick one): [ ]Visa [ ] Euro/Mastercard [ ] American Express [ ]Diners

CARD NO: __ __ __ __ : __ __ __ __ : __ __ __ __ : __ __ __ __ EXP.DATE: __ __ / __ __

  Authorizing Signature:
  

PURCHASE ORDERS ARE NOT ACCEPTED UNLESS GUARANTEED BY A CREDIT CARD NUMBER.

MAIL REGISTRATION FORM AND PAYMENT FORM COPY (1) / CHEQUE (2) / CREDITCARD INFO (3) TO:
The Society for Computer Simulation International,
European Simulation Office, University of Ghent,
Coupure Links 653, B-9000 Ghent, Belgium
Phone: +32-9-2337790, Fax: +32-9-2234941


This page last modified 03-02-03 by Alexander Verbraeck, Delft University of Technology / SCS Europe